SMART EM show

SMART EM

Summary: SMART EM is a medical podcast dedicated to evidence. If evidence is out there on a monthly topic, we'll find it and bring it to you, then you decide. No more accepting what you're told—it's time to hear about the data.

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Podcasts:

 SMART Cardiac Arrest: Pharmacotherapy | File Type: audio/mpeg | Duration: 7990

"Epi" The frenzied voice calling for drugs has become a cultural icon for resuscitation. It is a note of angst, and a flicker of hope, amidst the panic of cardiac arrest. The power of drugs for cardiac arrest has been largely unquestioned for decades. Now, a recent and growing body of high quality literature has emerged to challenge the status quo. It is a curious and rebellious mix of studies... and a challenge to faith. Is it time to leave the drug box behind? Find out.

 Antibiotics for Cirrhotic UGIB - a quickie | File Type: audio/mpeg | Duration: 1799

Cirrhotics bleed and they get infected. It is, apparently, a law of nature. Question is, when they're bleeding is it worthwhile to treat them prophylactically with antibiotics? This review is more of a snorkel than a deep dive, since the literature is both thick and thin: Thick enough to review, but thin enough to make a deep dive unnecessary. Join us for both a brief review, and a gloating rant.

 Upper GI Bleed 2 | File Type: audio/mpeg | Duration: 6227

In July we scoured the data on PPIs for ulcer bleeding. This month we tackle the other, often scarier cause of upper GI bleeding, esophageal varices. We dived deep (deeper than ever) to find the best and most relevant data on the commonly used pharmacologic agents for variceal bleeding: somatostatin analogues, like octreotide. This one was a twisted road, and there were a whole lot of pigs on the road. They were mostly wearing lipstick. Come with us to the zoo....

 The Placebo Paradox | File Type: audio/mpeg | Duration: 4778

Deep inside most medical providers there is a war of the psyche; a battle between art and science. We are ambassadors for ‘science’, true believers. Yet we are baffled and unsettled every day by events and conditions that defy the precepts on which we stand. The most ubiquitous emblem of this conflict is placebo. Placebo equals nothing. Doesn’t it? But common surgeries are proven no better than sham surgery. Entire classes of ubiquitous drugs are proven equal to placebo. Thus we may scoff at placebo, but we implicitly confess and embrace the power of placebo every day. This month on SMART EM, a reconciliation.

 Upper GI Bleed: PPI | File Type: audio/mpeg | Duration: 5824

Upper GI bleeds are common, and they’re messy. We wanted to know how good the data are for the pharmacological interventions that have become standard fare for upper GI bleeds. Turns out the data are messy too. In fact, because no one else would, we did our own little meta-analysis. Good news is we have a concrete answer on PPIs for upper GI bleeding. Bad news is that the news is not good. And not at all what we expected. FYI, check out the Rita Redberg editorial from the NY Times: http://www.nytimes.com/2011/05/26/opinion/26redberg.html?_r=2&scp=1&sq=redberg%20medicare&st=cse Or even your very own David Newman's editorial in the NY Times from 2009: http://well.blogs.nytimes.com/2009/04/02/the-ideology-of-health-care/    

 Heparin for Coronary Syndromes | File Type: audio/mpeg | Duration: 5154

Heparin is the world’s ‘standard-of-care’ anticoagulant for the treatment of coronary syndromes. Not only is heparin recommended by all cardiac guidelines, it’s also the reference standard against which new anticoagulants are compared. The answer to whether or not heparin during coronary syndromes saves lives, or provides meaningful benefits, is the answer to the effectiveness and validity of present and future of acute coronary therapy. This month we found the root literature on heparin, and walked through the studies and their results.  We have an answer.

 Threatened Ab: Knowledge is Power | File Type: audio/mpeg | Duration: 6764

Threatened abortion is among the most common conditions in outpatient settings. The explosive growth of ultrasound imaging, and increasingly limited access to specialty care have combined to make first trimester bleeding a disease for emergency and primary care docs. Thing is, there is no therapeutic intervention that can alter the course of ‘Threatened Ab’. Which means that knowledge is our only power—the power to guide and inform. As always, when it comes to evidence, seeing is believing. So we’re going to show you some evidence... otherwise you wouldn’t believe us. Keep an open mind, please

 CT Consent | File Type: audio/mpeg | Duration: 7288

We do it every day. Editorials and experts everywhere are asking us to do it more, and more completely. But no one ever showed us the numbers. So here it is, a reasonable, data driven set of risks that we can tell our patients who are considering undergoing CT scan. Risk of the dye, risk of the radiation, and risk of false positives. It’s all here, adults and kids alike. Deep dive in, this data is flat out fun.

 Chest Pain Risk | File Type: audio/mpeg | Duration: 2454

Risk stratification is the emergency physician’s best friend. We stratify, it’s what we do. So how likely is it that a 56 y/o gentleman with mild exertional chest pain, a non-diagnostic EKG, and a negative troponin is going to have an MI or die in the next 30 days? Covered. How about the 38 y/o with a good story? Done. What about the 47 year old diabetic with a decent story? Solved. This month we’ve got your rapid fire, quickie lecture on chest pain risk. It’s what we do.

 Otitis Media | File Type: audio/mpeg | Duration: 6574

Antibiotics for Otitis Media: Feel Better? Otitis media is the primary reason that children in western developed nations spend 6-7 weeks per year taking antibiotics before their 2nd birthday. Seriously. Is it worth it? What’s in it for them? What’s in it for moms and dads? Who are we helping and who are we hurting? Come on a deep dive through the swamps of the AAP guidelines, the strange world of antibiotic recommendations, and the clinical evidence for the treatment of ear infections. There’s a few surprises in the swamp.

 Pediatric UTI: It's About the Future | File Type: audio/mpeg | Duration: 7109

UTI’s are the ‘in thing’. Particularly with the heptavalent pneumococcal vaccine in play, and bacteremia increasingly a part of our past, UTI’s have become the number one concern in febrile children over 2 months of age. So if you’re wondering about how and why fevers matter in kids, and what to do about them, we’ve got your answer. Come with us on a dive where you’ll learn about why UTI’s matter, how they got top billing, and what to do about them. It’s not pretty. Also this month, a bonus track. Also, not pretty.

 Subarachnoid Hemorrhage: A Rational Approach | File Type: audio/mpeg | Duration: 6781

In October of 2010 the prestigious British Medical Journal published the largest, and by far the best, study ever done on the diagnosis of SAH in the ED. The data are revolutionary, and they prompted us to take a new look at the classic teaching and modern approach to this diagnosis. It’s always fun to deep dive on a new topic, and we hoped to combine the newest data with the classic data to find a safe, rational, and smart approach to the evaluation of high risk headache. What we found was more earth shaking than we could have imagined. Come take a journey to the center of the data, new and old... this changes everything.

 Minor Head Injury: Who Has The Badness? | File Type: audio/mpeg | Duration: 5924

Minor head injuries are a staple of urgent and emergent care medical practice. Primary care doctors, emergency physicians, and office practitioners everywhere have to make quick decisions about which patients may have the needle in the haystack—the serious intracranial injury. We scoured the literature for the most accurate predictors and the most valuable decision aids, and we found the good stuff. There is little need to fear the needle, we have your needle-finder. After this month’s SMART EM you’ll be doing less irradiating, more talking, and less stressing.

 Pulmonary Embolism: Diagnosis and Treatment | File Type: audio/mpeg | Duration: 7133

PE remains among the most discussed entities in medicine. The condition is known to be common, potentially deadly, and a clinical chameleon. This combination that has led to fear, uncertainty, and frequent over-testing. The irony is that PE is among the most well studied topics in clinical medicine. Therefore this month we studied the studies, and we have some surprising answers. To our delight we found that the data offers us a validated, rational approach to PE diagnosis that can reduce testing, and let our patients rest easier. All it took was a deep dive....

 Treatment of Acute Pharyngitis | File Type: audio/mpeg | Duration: 4920

At 14 million outpatient visits each year pharyngitis (sore throat) is a common complaint in any emergency department. This is an arena, however, where professional society guidelines and conventional teaching do not do justice to the existing data. We scoured the world’s literature for high quality data, and offer a comprehensive review of potential benefits and harms of antibiotic and symptom therapy for streptococcal pharyngitis.

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